Introduction: Treatment non-response occurs regularly, but psychotherapy is seldom examined for such patients. Existing studies targeted single diagnoses, were relatively small, and paid little attention to treatment under real-world conditions. Objective: The Choose Change trial tested whether psychotherapy was effective in treating chronic patients with treatment non-response in a transdiagnostic sample of common mental disorders across two variants of treatment delivery (inpatient and outpatient). Methods: The controlled nonrandomized effectiveness trial was conducted between May 2016 and May 2021. The study took place in two psychiatric clinics with N = 200 patients (n = 108 inpatients and n = 92 outpatients). Treatment variants were integrated inpatient care versus outpatient care based on acceptance and commitment therapy (ACT) for approximately 12 weeks. Therapists delivered individualized and non-manualized ACT. Main outcome measures were symptoms (Brief Symptom Checklist [BSCL]); well-being (Mental Health Continuum-Short Form [MHC-SF]), and functioning (WHO Disability Assessment Schedule [WHO-DAS]). Results: Both inpatients and outpatients showed decreases in symptomatology (i.e., BSCL: d = 0.68) and increases in well-being and functioning (MHC-SF: d = 0.60 and WHO-DAS: d = 0.70), with more improvement in the inpatients during treatment. Both groups maintained gains 1 year following treatment, and the groups did not significantly differ from each other at this timepoint. Psychological flexibility moderated impact of stress on outcomes. Conclusions: Psychotherapy as practiced under routine conditions is effective for a sample of patients with common mental disorders, a long history of treatment experience and burden of disease, in both inpatient and outpatient settings. Trial registration: This study was registered in the ISRCTN registry on May 20, 2016, with the registration number ISRCTN11209732.
Psychother Psychosom

中文翻译：

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患有常见精神障碍的慢性住院和门诊患者的心理治疗：“选择改变”有效性试验

简介：治疗无反应经常发生，但很少对此类患者进行心理治疗检查。现有研究针对单一诊断，规模相对较小，并且很少关注真实世界条件下的治疗。目标： Choose Change 试验测试了心理治疗是否能有效治疗慢性病患者，这些患者是跨诊断的常见精神障碍样本，跨越两种治疗方式（住院和门诊）。方法：对照非随机有效性试验于 2016 年 5 月至 2021 年 5 月期间进行。该研究在两个精神病诊所进行， N = 200 名患者（ n = 108 名住院患者和n= 92 名门诊病人）。治疗变体是综合住院护理与基于接受和承诺疗法 (ACT) 的门诊护理，持续大约 12 周。治疗师提供个性化和非手动化的 ACT。主要结果指标是症状（简要症状检查表 [BSCL]）；福祉（心理健康连续统一体简表 [MHC-SF]）和功能（世卫组织残疾评估表 [WHO-DAS]）。结果：住院患者和门诊患者均表现出症状减少（即 BSCL：d = 0.68）和健康和功能增加（MHC-SF：d = 0.60 和 WHO-DAS：d= 0.70)，住院患者在治疗期间有更多改善。两组在治疗后 1 年都保持收益，并且在这个时间点两组之间没有显着差异。心理灵活性调节了压力对结果的影响。结论：在常规条件下实施的心理治疗对于住院和门诊环境中患有常见精神障碍、长期治疗经验和疾病负担的患者样本是有效的。试验注册：本研究于2016年5月20日在ISRCTN注册中心注册，注册号ISRCTN11209732。
心理医生